Study: Postpartum Readmissions on the Rise

Infection and hypertension are the most common indications

A major goal of hospitals and health systems is to prevent 30-day readmissions among medical and surgical patients with conditions such as chronic obstructive pulmonary disease (COPD), heart failure, and hip and knee replacements. But, according to an article posted on the HealthLeaders Media website, there is one cohort of patients about which little is known––postpartum women.

A new study indicates that readmissions among these patients have been quietly rising. They increased from 1.7% in 2004 to 2.2% in 2011—a 27% jump—according to researchers at Brigham and Women’s Hospital in Boston.

Using state inpatient databases, the investigators identified postpartum readmissions occurring within the first six weeks after delivery in California, Florida, and New York between 2004 and 2011. Of the nearly six million eligible deliveries identified, 114,748 women were readmitted over the eight-year period. The researchers calculated the rates of readmissions and their indications by state and over time. The characteristics of the readmission stay, including the day readmitted, the length of readmission, and the charge for readmission, were compared among the diagnoses.

The study found that the readmission the rate increased from 1.7% in 2004 to 2.2% in 2011. Readmitted patients were more likely to be publicly insured than non-readmitted ones (54% versus 42%, respectively; P < 0.001); to be black (19% versus 14%, P < 0.001); to have comorbidities, such as hypertension (15% versus 2%; P < 0.001) and diabetes (13% versus 7%; P < 0.001); and to have had a cesarean delivery (37% versus 33%; P < 0.001). The most common indications for readmission were infection (16%), hypertension (9%), and psychiatric illness (8%).

Patients were readmitted, on average, seven days after discharge, but the readmission days varied by diagnosis: day 3 for hypertension, day 5 for infection, and day 9 for psychiatric illness. Maternal comorbidities were the strongest predictors of postpartum readmissions: psychiatric illness, substance use, seizure disorder, hypertension, and tobacco use.

The findings were published in the July 2016 issue of the American Journal of Obstetrics & Gynecology.

Sources: HealthLeaders Media; August 4, 2016; and AJOG; July 2016.